基于术前免疫炎症相关指标构建的新型列线图预测老年髋部骨折患者术后谵妄风险：一项单中心回顾性队列研究
A Novel Nomogram Developed Based on Preoperative Immune Inflammation-Related Indicators for the Prediction of Postoperative Delirium Risk in Elderly Hip Fracture Cases: A Single-Center Retrospective Cohort Study.
作者信息
Chen Xiao, Fan Yuanhe, Tu Hongliang, Chen Jie
机构信息
Department of Orthopedics, The First People's Hospital of Neijiang, Neijiang, Sichuan, People's Republic of China.
出版信息
J Inflamm Res. 2024 Oct 9;17:7155-7169. doi: 10.2147/JIR.S485181. eCollection 2024.
OBJECTIVE
Postoperative delirium (POD) commonly occurs in elderly individuals following hip fracture surgery, with unclear pathophysiological mechanism. Inflammation is a known factor affecting the onset of delirium. The current work aimed to examine the associations of preoperative immune inflammation-related indicators with POD occurrence in elderly cases following hip fracture surgery.
METHODS
The current retrospective cohort study included 437 elderly cases administered hip fracture surgery from January 2018 to December 2023. The clinicodemographic data and laboratory findings of all cases were retrospectively analyzed. Immune inflammation-related indicators were assessed, eg, MLR, NLR and PLR, as well as SII and SIRI. The bootstrap method was employed to assign cases at 7:3 to the training (48 and 258 cases in the POD and no-POD groups, respectively) and internal validation (13 and 118 cases in the POD and no-POD groups, respectively) cohorts. Next, LASSO, univariable and multivariable logistic regression analyses were applied to determine risk factors in the training cohort, based on which a nomogram model was built. The obtained nomogram was examined for accuracy by calibration plot analysis. Finally, the nomogram's clinical value was assessed by decision curve analysis (DCA), followed by internal validation based on the training cohort.
RESULTS
Of all 437 cases, 61 developed POD, indicating a POD incidence of 13.96%. LASSO regression and multivariable analyses revealed preoperative SIRI independently predicted POD in the training cohort. The developed nomogram had an area under the curve (AUC) of 0.991 (95% CI 0.9830.998) in the training cohort versus 0.986 (95% CI 0.9661.000) in the validation cohort. Calibration curve analysis revealed nomogram-predicted and actual probabilities were in line. DCA demonstrated the novel nomogram could confer net benefits for POD prediction in elderly cases administered hip fracture surgery.
CONCLUSION
The immune inflammation-related indicators SIRI could predict POD in elderly cases following hip fracture surgery.
目的
术后谵妄（POD）常见于老年髋部骨折手术后患者，其病理生理机制尚不清楚。炎症是影响谵妄发生的一个已知因素。本研究旨在探讨髋部骨折手术老年患者术前免疫炎症相关指标与POD发生的相关性。
方法
本回顾性队列研究纳入了2018年1月至2023年12月期间接受髋部骨折手术的437例老年患者。回顾性分析所有患者的临床人口统计学数据和实验室检查结果。评估免疫炎症相关指标，如MLR、NLR和PLR，以及SII和SIRI。采用自助法将病例按7:3分配到训练队列（POD组和非POD组分别为48例和258例）和内部验证队列（POD组和非POD组分别为13例和118例）。接下来，应用LASSO、单变量和多变量逻辑回归分析来确定训练队列中的危险因素，并据此建立列线图模型。通过校准图分析检验所得列线图的准确性。最后，通过决策曲线分析（DCA）评估列线图的临床价值，随后基于训练队列进行内部验证。
结果
437例患者中，61例发生POD，POD发生率为13.96%。LASSO回归和多变量分析显示，术前SIRI在训练队列中独立预测POD。所建立的列线图在训练队列中的曲线下面积（AUC）为0.991（95%CI 0.9830.998），在验证队列中为0.986（95%CI 0.9661.000）。校准曲线分析显示列线图预测概率与实际概率相符。DCA表明，新的列线图可为髋部骨折手术老年患者的POD预测带来净效益。
结论
免疫炎症相关指标SIRI可预测髋部骨折手术老年患者的POD。
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